Healthcare Provider Details

I. General information

NPI: 1386965499
Provider Name (Legal Business Name): OTHNIEL STEPHEN DOOLITTLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 N ILLINOIS AVE
CARBONDALE IL
62901-5612
US

IV. Provider business mailing address

2250 N ILLINOIS AVE
CARBONDALE IL
62901-5612
US

V. Phone/Fax

Practice location:
  • Phone: 618-833-1691
  • Fax:
Mailing address:
  • Phone: 618-833-1691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036.133193
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2013004979
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036133193
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.058047
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: